Santa Fe 2011 Santa Fe, USA 2011
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Abstract #102  -  Effectiveness of Motivational Interviewing on HIV risk behaviors among men who have sex with men: A systematic review of the best available evidence
  Presenting Author:   Dr Rigmor Berg - The Norwegian Knowledge Centre for Health Services
  Additional Authors:  Dr. Michael Ross, Dr. Ronny Tikkanen,  
In most areas of the world, despite the small size of their community, men who have sex with men (MSM) continue to be the population most affected by HIV. Among this group, the principal risk practice for HIV infection is unprotected anal intercourse (UAI), often engaged in under the influence of alcohol and other substances. Both behaviors are targeted through Motivational Interviewing (MI), a harm reduction approach that has been used to prevent HIV risk behaviors among this group for more than a decade, without its effectiveness having been systematically studied. We conducted a systematic review (SR) according to the Cochrane Handbook for Systematic Reviews of Interventions investigating the effectiveness of MI on HIV risk behaviors for MSM.
  Method / Issue:
We searched 9 electronic databases, Google scholar, databases of websites and newsletters relevant to MI, literature lists of 22 relevant reviews, and contacted experts. Two reviewers independently appraised records and full-text papers for inclusion. They extracted data using a pre-designed data recording form, performed risk of bias assessment using Cochrane's risk of bias tool, and used the instrument Grading of Recommendations Assessment, Development and Evaluation (GRADE) with GRADE-Profiler to assess the extent to which we could have confidence in the estimate of effect. Finally, Mantel-Haenszel random effects meta-analyses for dichotomous outcomes and inverse-variance random effects meta-analyses for continuous outcomes were used to pool results.
  Results / Comments:
The searches yielded 255 unique records, of which 10 randomized controlled trials were included. Risk of bias was generally moderate or low. With the exception of one study from the Netherlands, all were from the U.S. In total, they included 6,051 participants at baseline. Nine outcomes were sufficiently similar to compute meta-analyses. The quality of these outcomes was judged as moderate (GRADE). There was no significant difference between the group receiving MI and the control group for seven sexual behavior outcomes: unprotected anal intercourse (UAI) with nonprimary partner (RR=1.06, 95%CI= -4.71, 6.84), UAI with primary partner (RR=1.02, 95%CI= -6.43, 8.48), number of sexual partners (MD=0.34, 95%CI= -0.91, 1.58), UAI at short term follow up (MD=0.13, 95%CI= -0.15, 0.40), UAI at medium term follow up (MD=-0.09, 95%CI= -0.49, 0.31), UAI at long term follow up (MD=-0.08, 95%CI= -0.33, 0.17), condom use (MD=-0.06, 95%CI= -0.32, 0.20). The meta-analysis for drinks per day at short term follow up was significant (MD=-1.24, 95%CI= -2.04, -0.43), but failed to reach significance at long term follow up (MD=-0.29, 95%CI= -0.74, 0.16). None of the meta-analyses showed statistically significant heterogeneity (max I2= 36%).
The effectiveness of MI as a prevention strategy for unsafe sexual and substance use behaviors among MSM does not appear promising. To dismiss MI as an intervention for all HIV risk behaviors among all groups of MSM, however, is premature. The results of this SR demonstrates that crafting suitable HIV prevention programming for MSM remains a challenge for today's health promotion community.
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